Abstract: Obstructive Sleep Apnea (OSA), where patients stop breathing numerous times during sleep, is a disorder linked to serious medical, socioeconomic, and psychological morbidity, yet most patients with OSA remain undetected. Physicians should consider symptoms of frequent/loud snoring, complaints of daytime sleepiness or fatigue, high blood pressure and obesity or excessive body fat distribution in the neck or upper chest area as possible indications of untreated OSA.
Untreated OSA is associated with significant morbidity and mortality and results in increased healthcare utilization.
OSA is more prevalent in individuals with a chronic medical illness.
Almost 90% of individuals with OSA remain undiagnosed.
Treatment of OSA improves medical outcome; this is particularly relevant in medically ill patients.
Evidence-based medicine supports screening for OSA as part of routine clinical care.
Newer technology allows doctors to 'skip the waiting line' and obtain quick and accurate sleep testing for their patients.
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Treatment-Resistant Hypertension among Older Adults
Fatemeh Akbarian, MD, Dermatologist, Clinical Research Fellow, University of Toronto, Toronto, ON. Vahid Ghafarian, MD, MPH, BSc.PT, Physiotherapist, Northpark Physiotherapy and Annex Retirement Residence, Toronto, ON. Mohammad Ali Shafiee, MD, FRCPC, General Internist, Nephrologist, Department of Medicine, Toronto General Hospital, University Health Network; Clinician Teacher, University of Toronto, Toronto, ON.
Treatment-resistant hypertension (TRHTN) is a common challenge in geriatric practice and a significant cause of mortality and morbidity among older adults. In this overview, we will use a case-based approach to define the magnitude of the problem, identify characteristics of individuals with TRHTN, and explore the causes of uncontrolled hypertension including technical issues, patient-related and physician-related factors, and secondary causes of hypertension. We will then provide a simple approach to the problem, illustrating straightforward diagnostic workup and therapeutic options. In our approach most of the emphasis has been given to detailed history-taking and a targeted physical examination. Key words: resistant hypertension, hyperaldosteronism, obstructive sleep apnea, older adults.